hamstring stretching may not reduce hamstring injury.

References 1. Petersen P, Holmich P. Evidence based prevention of hamstring injuries in sport. British Journal of Sports Medicine 2005;39:319–323 2. Orchard J, Marsden J, Lord S, Garlick D. Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian football. American Journal of Sports Medicine 1997;25:81–85 3. Orchard J, Seward H. Epidemiology of injuries in the Australian football league seasons 1997–2000. British Journal of Sports Medicine 2002;36:39–44 4. Verrall G, Slavotinek J, Barnes P. The effect of sports specific training on reducing the incidence of hamstring injuries in professional Australian Rules football. British Journal of Sports Medicine 2005;39:363–368 5. Witvrouw E, Mahieu N, Danneels L, McNair P. Stretching and injury prevention: an obscure relationship. Sports Medicine 2004;34:443–449 6. Kubo K, Kanehisa H, Kawakami Y. Effects of resistance and stretching training programmes on the viscoelastic properties of human tendon structures in vivo. Journal of Physiology 2002;90:511–519 7. Whatman C, Knappstein A, Hume P. Acute changes in passive stiffness and range of motion post-stretching. Physical Therapy in Sport 2006;7:141–150 8. Pope R, Herbert R, Kirwan J, Graham B. A randomised trial of preexercise stretching for prevention of lower limb injury. Medicine and Science in Sports and Exercise 2000;32:271–277 9. Brockett C, Morgan D, Proske U. Human hamstring muscles adapt to eccentric exercise by changing optimum length. Medicine and Science in Sports and Exercise 2001;33:783–790 10. Clark R, Bryant A, Culgan JP, Hartley B. The effects of hamstring strength training on dynamic jumping performance and isokinetic strength parameters: a pilot study on the implications for the prevention of hamstring injuries. Physical Therapy in Sport 2005;6:67–73 11. Pull M, Ranson C. Eccentric muscle actions: implications for injury prevention and rehabilitation. Physical Therapy in Sport 2007;8:88–97 12. Mjolnes R, Arnason A, Osthagen T, Raastad T, Bahr R. A 10 week randomised trial comparing eccentric exercise vs concentric hamstring strength training in well trained soccer players. Scandinavian Journal of Medicine and Science in Sports 2004;14:311–317 13. Arnason A, Andersen T, Holme I, Engebretsen L, Bahr R. Prevention of hamstring strains in elite soccer: an intervention study. Scandinavian Journal of Medicine and Science in Sports 2008;18:40–48 14. Witvrouw E, Danneels L, Asselman P, D’Have T, Cambier D. Muscle flexibility as a risk factor for developing muscle injuries in male professional soccer players.

16

KEY POINTS

n Evidence shows that the incidence of hamstring injury can be reduced by preventative n A lack of good quality evidence leads to conflicting information n Research has shown a significant increase in knee range following hamstring stretching which lasts up to 20 minutes but it’s unknown whether reduces injury n There is conflicting evidence regarding increasing flexibility outside the pre-exercise time n Evidence does suggest that increasing hamstring flexibiltiy in the long term will increase the ability of the muscle to absorb energy and therefore reduce injury risk n Rolls and George however found no clinical significance between hamstring flexibility and injury rate n Evidence does suggest that hamstring injury does occur mainly in the eccentric phase and strengthening the hamstring muscles eccentrically can reduce hamstring injury n Several studies support that the greater the range through which the muscle is weak, the greater the risk of injury n While eccentric strengthening may reduce hamstring injury risk, it also induces DOMS and this should be considered when incorporating into training programmes

American Journal of Sports Medicine 2003;31:41–46 15. Gogia P, Braatz J, Rose S. Reliability and validity of goniometric measurements of the knee. Physical Therapy 1987;67:192–195 16. Lew P, Puentedura E. The straight leg raise test and spinal posture, (is the straight leg raise a tension test or a hamstring length measure in “normals”?). Proceedings of the Manipulative Physiotherapists Association of Australia 1985;183–206 17. Rolls A, George K. The relationship between hamstring muscle injuries and hamstring muscle length in young elite footballers. Physical Therapy in Sport 2004;5:179–187 18. Hopkins D, Hoeger W. A comparison of the sit and reach test and the modified sit and reach test in measurement of flexibility for males. Journal of Applied Sport Science Research 1992;6:7–11 19. Gajdosik R, Lusi G. Hamstring muscle tightness: reliability of an active knee extension test. Physical Therapy 1983;7:1085–1090 20. Butler D. Mobilisation of the nervous

system. Churchill Livingstone 1991. ISBN 0443044007 21. Kujala U, Orava S, Jarvinen M. Hamstring injuries: current trends in treatment prevention. Sports Medicine 1997;23:397– 404 22. Weldon S, Hill R. The efficacy of stretching for prevention of exercise related injury: a systematic review of the literature. Manual Therapy 2003;8:141–150.

TH U THE AUTHOR then moved to the Calderdale and

Alison Tooley graduated from Hertfordshire University in 2003, completed her junior rotation at Bradford Teaching Hospitals, ed to the Calderdale and Huddersfield Trust

graduated from eaching

as a Band 6 where she currently works. In 2003 she became the academy physiotherapist at the Bradford Bulls Rugby League Football Club where she rehabilitates athletes from the reserve grade to scholarship players, including running the pitch on match days. She is currently undertaking an MSc at Bradford University and runs a private clinic in Halifax.

The online version of this article has a number of active components:

n Animation reviewing the

anatomy and actions of the three hamstring muscles

n Link to animated hamstring patient advice leaflet

n Video showing the Nordic hamstring exercise

online

Click on the images to see these interactive extras

sportEX medicine 2009;39(Jan):12-16